Provider Demographics
NPI:1336416007
Name:HALL, GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4767
Mailing Address - Country:US
Mailing Address - Phone:404-255-1933
Mailing Address - Fax:404-256-7924
Practice Address - Street 1:5445 MERIDIAN MARK RD STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4767
Practice Address - Country:US
Practice Address - Phone:404-255-1933
Practice Address - Fax:404-256-7924
Is Sole Proprietor?:No
Enumeration Date:2011-11-24
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6647363A00000X
GA006647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101403Medicaid
NCNC3890JMedicare PIN
NCNC3890BMedicare PIN
NCNC3890GMedicare PIN
NC8101403Medicaid
NCNC3890HMedicare PIN
NCNC3890DMedicare PIN
NCNC3890FMedicare PIN
NCNC3890AMedicare PIN
NCNC3890MMedicare PIN
NCNC3890EMedicare PIN
NCNC3890IMedicare PIN
NCNC3890KMedicare PIN
NCNC3890LMedicare PIN